Provider Demographics
NPI:1619335239
Name:CENTRAL VALLEY RECOVERY SERVICES, INC.
Entity Type:Organization
Organization Name:CENTRAL VALLEY RECOVERY SERVICES, INC.
Other - Org Name:NEW VISIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KLUVER
Authorized Official - Suffix:
Authorized Official - Credentials:CATC
Authorized Official - Phone:559-625-2995
Mailing Address - Street 1:1425 E WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93292-1415
Mailing Address - Country:US
Mailing Address - Phone:559-625-4072
Mailing Address - Fax:559-625-4729
Practice Address - Street 1:1425 E WALNUT AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93292-1415
Practice Address - Country:US
Practice Address - Phone:559-625-4072
Practice Address - Fax:559-625-4729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA540031CN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5430031CNOtherSTATE OF CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES LICENSE AND CERTIFICATION